December 19, 2012

If Psychiatry Were Easy, Everyone Would Be Doing It

by Angela Mohle

I’ve heard a million rumors about Adam Lanza’s history and I’ve chosen to believe none of it. Nobody seems to have the truth but one thing everyone has agreed on is that the man, as a younger man, had a lot of prescriptions for mental illness doled out to him. As someone who has been medicated for over 20 years, I just have to weigh in on all of this.

While I have never shot up a school, I can understand the feeling. I was a really messed up teenager. I threatened a lot of violence on a lot of people. I followed through on some of it. I wasn’t on medication yet I needed to be. I hurt a lot of people, especially my parents. However, I never shot up a school. Did I mention that? You know why? Because I was honest with my doctors.

Psychiatry does not work if the patient is not honest with themselves and their doctors. Sometimes patients don’t even know what they’re going through, but just being honest about feelings will make all the difference. The roadblock to that, however, is that it takes practice. I should know; I went through 15-ish doctors before I found a decent one. Insurance company operation policies made things even worse.

My insurance company had some stupid policy where I was only able to see a psychiatrist for the prescriptions only. I was only allowed to see a psychologist for the actual therapy. Did they confer or even look at the same files? I saw no evidence to support that theory. What I do know is that my psychiatric medication checkup would consist of nothing more than this:

Dr: “So. How are your side effects?”

Me: “Well, I don’t know. I guess I feel okay.”

Dr: “Have you been sleeping normally?”

Me: “Normal as in MY normal, or normal as in ‘these meds should be making you sleep better’ normal?”

Dr: “Well, have you been sleeping at least 7 hours?”

Me: “As long as I take the Ambien, yes.”

Dr: “Do you have enough or do I need to request a refill?”

Me: “I have enough.”

Dr: “So you’re okay, then?”

Me: “I guess.”

Dr: “Okay. Well, then I’ll see you in two weeks to see if we need to adjust your medications.”

Me: “Um. Okay.”

The psychologist wasn’t much more helpful, either. There was no advice given, just listening. I didn’t understand why I couldn’t just get a doctor to really help me; it’s not like I will ever be “well.” Even as a teenager I knew my illness might be managed, but I would never be cured. It also took me many years to realize that not everyone felt the way I did. Being biologically miserable isn’t normal and not everyone thinks life is worthless.

That could also bring up a ton of complaints about misdiagnoses, depending on the flavor of the month mental illness, but I’ll save it.

At some point, I finally found a doctor who cared. One who understood I really wanted to help myself. Somehow, I got lucky enough to find a psychiatrist who would do therapy as well as dispense medication. When I compared my current doctor with the years of talking with different doctors, it occurred to me that there were two reasons I’d never made progress. One was that my doctors hadn’t been asking the right questions; the kind that begged for introspection and honesty. The other was that I hadn’t really been considering what I needed as a patient and how to evaluate my own needs, or realize that I needed to think carefully about how to help my doctor help me.

There have been times I’ve lied to my doctor because I didn’t want to face the truth of how to handle it, or because I was afraid that a stint in a mental facility would be suggested, or because I didn’t want to admit it happened. I was so embarrassed about ne dumb thing I did that I cancelled my next appointment and avoided my doctor for two months.

I was having negative side effects to a medication that was causing me to stay in a manic state. Hypomania, they call it. I was obsessed with it; I loved it. I felt invincible, I was having fun, and I it was like I was living in a dream. I felt spontaneous and interesting. People would comment about how amazing and crazy my life was. I took that as a compliment. Had I not been honest with my doctor, I probably would have allowed that hypomania to kill me.

The point to all of this self-indulgent bull is that I want people to realize that doctors aren’t gods, wizards, or mystics. They are only as powerful as the patient allows them to be. If a patient is having suicidal thoughts, a doctor can’t do anything if the patient isn’t honest; they can’t read minds even though they can pick up on cues. If a patient isn’t at a place where introspection is part of their desire to help themselves, there’s nothing a doctor can do for them.

Even with bloodwork and careful observation, no one can predict how a drug will affect someone. It requires self-reporting. It’s not that common, but it does happen where a drug will have the opposite of the desired effect. Yes, it happens, and that’s why involvement of family, friends, and the doctor is so incredibly important.

I don’t exactly what Lanza’s deal was, medically-speaking. I’ve heard depression, oppositional defiant disorder, a lack of impulse control, Asperger’s, straight up Autism…whatever. There is no one factor that caused this tragedy. It’s clear that Lanza was a troubled person from way back and it just sucks that it happened. My heart hurts because I can see both sides; the tortured soul, angry at the world who may have been thinking he was “saving” those children from living miserable lives, but I also see the teachers’ side, and the terrified students’, and the tidal waves that have affected thousands of lives, directly and indirectly. And it just sucks. My heart goes out to both sides of this tragedy.